Leg Strength Imbalance after Knee Surgery: How to Proceed?

[Plato209]

Hi guys,

I am now just over two months into recovery from my knee surgery, which the surgeon termed "medial patellofemoral ligament reconstruction with lateral reticular release."

As a consequence of my leg being immobilized I have lost around 70% of the strength in both my left leg quad and hamstring muscles (I tested both legs with a leg press and leg curl machine). At this point both my physiotherapist and my surgeon have said that I can squat using my judgment, but my concern here is what to do about the leg strength imbalance.

Should I just start squatting (and deadlifting) from an empty bar and work my way up with say 5 lb increments and trying for perfect form, assuming that the leg strength will return and balance out on its own? Or should I also be concentrating on trying to use 75% of my left leg to do the lift (in order to overshoot and help force a balance) as my physiotherapist suggested? I am also considering adding glute ham raises to replace the power clean (not a safe option yet) and help strengthen my left hamstrings; any thoughts on this?

I searched around but could find nothing on this topic. Though I found a lot of Rip's comments on Bill Starr's rehab protocol, and how it should never be used for joint injuries, and that you should just leave joint injuries the heck alone. So I am still a bit worried about overdoing anything right now.

Thanks for you time.

[veryhrm]

1) I don't think you searched very hard:
"site:startingstrength.com imbalance" yields many threads. Including this one:
http://startingstrength.com/resource...ad.php?t=22094
Which i recommend for its comedic content and surely it should be included in the uFAT in the section on nuthugging.

2) my leg went through a similar loss of size after ACL surgery. I didn't do SS back then but i think just doing the normal barbell lifts is the only thing i've seen Rip mention on the board and thinking of how my leg worked back then i'd add my anecdotal thumbs up. Just stay at the weight that you can do symmetrically as you suggest. Do you have adequate ROM yet?

3) out of curiosity, was your surgery due to a specific injury or just "knee pain". I know little about these things but esp the "with lateral reticular release" part i think is regarded around here as unnecessary/ill advised hatchet job stuff for things that should instead be fixed by strengthening the knee through proper squatting instead.
[edit: NM. read the story here http://startingstrength.com/resource...556#post442556 i guess when you have actual dislocations all the time something more needs to be done.)

(i am not a doctor; this isn't advice; don't do or not do anything)

[Plato209]

Thanks for the link. I had decided to start from an empty bar (and one plate for deadlifts) and progress normally without trying to use my weaker side more, but just trying to keep everything balanced with best normal form. I am glad that Mark seems to agree, and so did another strength training coach I asked.

After a few weeks of this I am very happy with this decision and the progress I have been making.